Innovation blog: IV fluids for Land Cruisers - the big decisions and a small disaster

14 February 2017

Many of our projects are located in places which simply aren’t accessible for normal ambulances. Using 4x4 cars gets us where we need to be, but teams can lose valuable time as they figure out how to hang the IV fluids that are vital to keeping our sickest patients stable.

Josie and Anup are an MSF nurse and logistician who have just three weeks to find a solution. They blog from Week Three...

Five days left and so much to do!

The first of the big decisions

We now had prototypes that fitted many of the criteria we’d identified during our information gathering stage. However, there were certain criteria we were purposefully ignoring in order to allow the creative juices to flow!

These ‘ignored’ criteria would play a major role in deciding which direction our design would take, and so the time had come to take our heads out of the sand.

The two criteria we had ignored were:

How does the IV fluid holder get to the field?

  •  Pre-installed in the Land Cruiser before it arrives in the field.
  • Added to the MSF supplies list, which is a list of all medical and non-medical items that the field can order to run their projects.
  • A ‘recipe’ that explains how an IV fluid holder can be made with materials easily found in MSF projects

Ownership: who takes responsibility for the IV fluid holder?

An IV fluid holder is used by medics and therefore considered a medical item, while the Land Cruisers are the responsibility of the technical logisticians. If we decided the IV fluid holder was pre-fitted in the Land Cruiser, then who was responsible for maintaining and cleaning it?

These decisions would significantly impact on our design, so to help us choose we wrote out positives (green) and negatives (red) for each option. In black we wrote what the designs would need to achieve to make them successful e.g. being simple to clean. 

 

The whiteboard outlining the two big decisions

The two big decisions! Photo: MSF / Fearsome.

Looking at all these aspects, the first major issue we discussed was the possibility of the IV fluid holder getting lost. If we made it detachable from the Land Cruiser this would always be a possibility, meaning all our work would be lost too.

However, the second major issue was how it could be cleaned to reduce the risk of spreading infections. If we made it detachable it could be cleaned with other medical equipment, however if it was fitted in the Land Cruiser would the driver then be responsible for cleaning it correctly, as they are responsible for cleaning the rest of the car?

Weighing up these two issues was difficult. I liked the idea of the IV fluid holder being detachable, but Nils, the project design engineer we are working with, and Anup both preferred the idea of it being attached.

A debate ensued and I had to lay out my reasons for wanting the IV fluids holder to be detachable. This was a huge decision. In the end, we ruled out our detachable ideas and prototypes. This meant we could really start to narrow in on what our final design would be like.

OK, one decision down.

Having decided that the IV fluid holder would be fixed inside the Land Cruiser, now we had to decide: where?

We did not want to start drilling holes in the Land Cruiser as this could affect its stability and safety. We identified a place on the side of the car where there were already two holes with bolts in, and decided to use these. There is also a grey bracket that is clipped in place to cover these screws and we thought there could be a way to remodel that bracket into part of our IV fluid holder!

The grey brackets and the hidden screws

Grey brackets and the screws hidden behind them. Photo: Fearsome / MSF.

We were getting excited and technical now!

From our prototypes, we knew that we wanted a spine or backing for the IV fluids to rest against and then we needed a waistband to hold the IV fluids in place while the Land Cruiser was moving.

Waistband production

With decisions made we embarked on a mass production of waistbands using all kinds of materials. At one point while searching for ideas I had pictures of bra straps, suspender belts and resistance bands used for fitness on my computer screen.

Once made, these like all other prototypes, were photographed and videoed in use and getting shoogled (currently our favourite Scottish word: to shake up and down).

We came up with five different waistbands. Then Nils had the idea of all ideas!

Nils suggested we make an IV fluid holder out of the grey bracket, flipping it down from its normal position to reveal a hook, and using the flipped bracket as a case for the IV fluids to rest in, with a waistband to hold them in place! 

Whiteboard designs of The Clam

Nils’ idea “The Clam”. Photo: Fearsome / MSF.

This was our 6th idea and now we decided we had to start comparing and scoring each idea, so we went back to the whiteboards.

Whiteboards scoring the final prototypes of the IV fluid holders

Scoring the final prototypes. Photo: MSF / Fearsome.

We assessed each of these designs against eight critical criteria and gave them scores between one and four.  A score of four was the best, while a score of one was the worst. This narrowed it down to two choices, the Spine and the Clam.

It really felt like we were getting there, making big decisions that would lead us to our final product.

Thursday morning arrived and we had two ideas and two days of the project left! With the Clam being more complicated and requiring the use of fancy technology, we decided to hone in on the Spine.

This was the simplest design and we knew we could have a prototype ready for Friday. So, we started making two different versions of the Spine.

We drew out the designs with the exact measurements and headed straight for the workshop. Not being able to find the material we wanted for the waistband, I headed into Glasgow city centre in search of resistance bands, the ones made of Latex and used for exercise.

I returned excited with what I’d found and headed back to the workshop to have them added to the Spine. For the first time, we decided to go the extra mile with our prototypes. These where the two we would choose between so we wanted to take a little more time and make them look good.

Then with both Spines in hand and feeling confident we headed to our Land Cruiser for testing. We got them attached and instantly realised they were not going to work!

The latex was too sticky and too tight and it was a struggle to get the IV fluids through the waistband and up onto the hook. It was also clear that we would not be able to calculate the elasticity of the waistband correctly in order to fit different sized bags.

With only a day to go, this was by far the worst prototype we’d made so far. You could feel the energy leave the room, we were so deflated.

The failed IV holder with the latex bellyband

The disaster!  Photo: MSF / Fearsome.

However, there was no time to dwell on it. Idriss, an ex-logistician who first had the idea for this project, was coming up from London to see how everything was going. We’d agreed to talk through the last few weeks with him before we had the big reveal of the final prototype tomorrow.

Only now, with only 24 hours to go, we don’t have a prototype. 

Will the team find a solution? Click here to read Josie and Anup's final blog post.

 

Read more...

> 1. Josie and Anup blog about the background to the project 

> 2. Anup and Josie blog about the getting the project started 

> 3. Josie and Anup blog about the first prototypes